Putatively lethal ingestion of isopropyl alcohol-related case: interpretation of post mortem isopropyl alcohol and aceto
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CASE REPORT
Putatively lethal ingestion of isopropyl alcohol-related case: interpretation of post mortem isopropyl alcohol and acetone concentrations remains challenging Carine Dumollard 1 & Jean-François Wiart 1 & Florian Hakim 1,2 & Christophe Demarly 3 & Philippe Morbidelli 3 & Delphine Allorge 1,2 & Jean-Michel Gaulier 1,2 Received: 11 May 2020 / Accepted: 14 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Isopropyl alcohol, or propan-2-ol (IPA), is found in numerous chemicals including alcohol-based hand rubs whose use has been recently widely extended to the general population since the onset of the COVID-19 pandemic. This widespread of IPA use could potentially, but not necessarily, be responsible for an increase in IPA poisoning cases (e.g., in alcoholics and/or for suicide attempt, even more in a lockdown situation). Forensic identification of IPA-related fatalities remains challenging as IPA post mortem detection can also result from antemortem or post mortem production, or post mortem contamination. In order to illustrate this issue, we report the case of a 33-year-old man found dead with a bottle of pure IPA liquid close to him. Toxicological positive results only consisted in IPA (464, 260, 465 and 991 mg/L) and acetone (1560, 2340, 3040 and 1360 mg/L) in blood, vitreous humour, urine and bile, respectively (determinations using headspace gas chromatography with flame ionization detection). These IPA absolute concentrations and IPA-to-acetone ratios appear inferior to those usually reported in the literature (higher than 1000 mg/L and 1.1, respectively) in IPA poisoning cases. In conclusion, this death can be cautiously regarded as an IPA ingestion-related fatality in the hypothesis of a survival time which have promoted IPA metabolism to acetone: this hypothesis is supported by the putative limited IPA-ingested dose. This report emphasizes the fact that post mortem IPA and acetone concentration interpretation involves to take account of (i) results in multiple biological specimens, (ii) complete case history, and (iii) a search of possible IPA presence at the scene of death. Keywords Forensic . Toxicology . Fatality . Isopropanol . Acetone
Introduction Isopropyl alcohol, propan-2-ol, or isopropanol (IPA) is a flammable and colourless liquid with a fruity odour and a slightly bitter taste. Cheap and easy to obtain, IPA is found in numerous industrial and household chemicals. As a result, IPA can be present in hand sanitizers or alcohol-based hand rubs (ABHRs that typically contain combination of alcohols:
* Jean-Michel Gaulier [email protected] 1
CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France
2
ULR 4483 – IMPECS – IMPact de l’Environnement Chimique sur la Santé humaine, Univ. Lille, Lille, France
3
CHU Lille, Service de Médecine Légale, Lille, France
IPA, ethanol and/or n-propanol), and also in home cleaning products, disinfectants, antifreezes, cosmetics, solvents and skin lotions… [1]. It is noteworthy that since the onset of
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